The dramatic increase in the use of interventional spine procedures and the rising health care costs over the past decade have raised lots of questions about the utilization and outcomes of treatments for back and neck pain. Several articles have addressed some concerning scenarios related to spinal surgeries, and catastrophic adverse events after epidural steroid injections have been reported, related to steroid use. The purpose of this study is to describe and characterize the treatment of back and neck pain, while examining temporal and geographical trends, physician specialty, and setting variations. We will characterize treatment trajectories in newly diagnosed back and neck pain patients, and identify efficient treatment paths and potential gateways to high cost and utilization. The characterization of patients treatment paths will include tracking of manual and percutaneous treatments, use of opioids, imaging utilization, surgical procedures, and safety events. We will examine the outcomes and adverse events following interventional spinal procedures by tracking patients for at least one year after their procedures. Identifying efficient and safe treatment paths for back pain will lead to better guidelines for back pain management. A characterization of the outcomes and side effects of interventional spinal procedures will help patients and physicians make more informed decisions about treatment options. Data Two datasets will be used for this project: Medicare administrative health records for patients diagnosed with back pain between 2000-2011, and United Healthcare administrative health records and electronic medical records for patients diagnosed with back pain currently available in their dataset. A contract to access this data has been established between NIH and CMS. A contract to access the United Healthcare data is currently being developed between NIH and Optum Labs. Since the previous annual report, we have achieved the following: Purchased a seat for access to a CMS virtual environment (CCW Enclave) that allows the analysis of CMS data in SAS, on CMS servers. Produced preliminary results based on a subset of the data of interest and evaluated the feasibility of future work. Presented preliminary results at academic conferences and meetings. Submitted a data addendum request to CMS, who approved the proposal. Obtained access to CMS Carrier, Inpatient, Outpatient, and Part D files for the years 2000-2011 for almost 47 million patients with diagnoses of back pain. Started collaborations with academic partners. Identified codes of diagnoses, procedures, drugs, complications, and outcomes relevant to our projects. We are in the process of replicating the preliminary results using the new data set. Submitted a project proposal to Optum Labs for accessing United Healthcare data and working in their virtual environment; the proposal has been approved Currently developing contract with Optum Labs for accessing their data and virtual environment.